ASGE Postgraduate Course at ACG 2022: Expanding the Scope of Fundamental and Advanced Endoscopy (On-Demand) | October 2022-9_Chahal

9_Chahal_Clear the Path PapillaryBalloonDilation

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The document discusses the use of endoscopic papillary large balloon dilation (EPLBD) in the management of bile duct stones. It provides practical tips for performing EPLBD, including the size of the balloon and the duration of inflation. The document recommends performing EPLBD in patients with large bile duct stones, along with endoscopic sphincterotomy (ES), as it has shown higher overall clearance rates and a lower need for mechanical lithotripsy compared to ES alone.<br /><br />Several studies have been conducted comparing EPLBD with ES alone, and the results show that EPLBD is more effective in stone clearance and has fewer adverse events. The document presents the findings of these studies, including the complete clearance index and adverse event rates.<br /><br />In terms of technology, EPLBD is considered more applicable, capable, and easy to use compared to cholangioscopy. It has better interoperability and ease of integration, and its adoption and maintenance cost is much lower compared to cholangioscopy.<br /><br />The document also provides a summary of the recommended treatment approach based on the size of the bile duct stones. For stones measuring 1-2 cm, EST+EPLBD+/-mechanical lithotripsy is suggested. For stones measuring 2-3 cm, EST+EPLBD+mechanical lithotripsy is recommended. If these treatment options fail, cholangioscopy with electrohydraulic or laser lithotripsy is considered for stones larger than 3 cm.<br /><br />Overall, the document highlights the effectiveness and cost-effectiveness of EPLBD in the management of bile duct stones, making it a widely available option for endoscopic retrograde cholangiopancreatography procedures.

Keywords

endoscopic papillary large balloon dilation

EPLBD

bile duct stones

endoscopic sphincterotomy

mechanical lithotripsy

stone clearance

adverse events

cholangioscopy

treatment approach

endoscopic retrograde cholangiopancreatography